Department of Global Health, Academic Medical Centre, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Curr Opin HIV AIDS. 2013 Jan;8(1):50-8. doi: 10.1097/COH.0b013e32835b809d.
Public health experts are wrestling with how to translate recent scientific findings from pre-exposure prophylaxis (PrEP) effectiveness trials into real-world programmes. This review summarizes clinical trial findings on oral and topical PrEP, discusses how decision-makers can evaluate the place of PrEP within combination prevention and highlights anticipated developments that could be important in future HIV-prevention strategies.
PrEP taken daily as oral tablets to create systemic protection has been found to be effective in the Pre-Exposure Prophylaxis Initiative (iPrEx), Partners' PrEP and TDF2 trials, but not in Fem-PrEP or the Vaginal and Oral Interventions to Control the Epidemic (VOICE) tenofovir arm. Tenofovir gel for topical protection was effective in CAPRISA 004 when used peri-coitally but not in VOICE with daily use. These findings underscore the importance of adherence to achieve adequate drug levels and the potential additive role of PrEP within combination prevention. Pivotal phase III trials are underway of the dapivirine ring, whereas phase I trials of injectable formulations show promise.
Antiretroviral-based HIV-prevention programmes should be tailored to those most likely to be adherent, providing them with state-of-the-art counselling and support to achieve high adherence during the time period of use. Long-acting products, if found well tolerated and effective, could be ideal for overcoming adherence challenges.
公共卫生专家正在努力探讨如何将最近的暴露前预防（PrEP）效果试验的科学发现转化为现实世界的项目。本综述总结了口服和局部 PrEP 的临床试验结果，讨论了决策者如何评估 PrEP 在联合预防中的地位，并强调了未来 HIV 预防策略中可能重要的预期发展。
每天口服片剂以产生全身保护的 PrEP 已在暴露前预防倡议（iPrEx）、伙伴 PrEP 和 TDF2 试验中被证明有效，但在 Fem-PrEP 或阴道和口服干预以控制流行（VOICE）中的替诺福韦手臂中无效。在 CAPRISA 004 中，当局部使用时，泰诺福韦凝胶作为局部保护是有效的，但在 VOICE 中每天使用则无效。这些发现强调了实现足够药物水平的重要性，以及 PrEP 在联合预防中的潜在附加作用。关键性的 III 期试验正在进行中，评估双夫定环，而注射制剂的 I 期试验显示出前景。
基于抗逆转录病毒的 HIV 预防方案应针对最有可能坚持使用的人群进行定制，为他们提供最先进的咨询和支持，以在使用期间实现高依从性。如果发现长效产品耐受性良好且有效，它们可能是克服依从性挑战的理想选择。
